Prebiopsy multiparametric 3T prostate MRI in patients with elevated PSA, normal digital rectal examination, and no previous biopsy

Purpose To find the diagnostic accuracy of 3T multiparametric magnetic resonance imaging (mpMRI) and mpMRI targeted transrectal ultrasound (TRUS)-guided biopsy using visual coregistration (TB) in patients with elevated prostate-specific antigen (PSA), normal digital rectal examination, and no previous biopsy. Materials and Methods Fifty-five patients at two institutions underwent mpMRI, consisting of anatomical T-weighted imaging (TW), diffusion-weighted imaging (DWI), proton magnetic resonance spectroscopy (H-MRS), and dynamic contrast-enhanced MRI (DCE-MRI), followed by TB in addition to 12 core systematic TRUS-guided biopsy (SB). Histopathological scorings of biopsy (n=38) and prostatectomy (n=17) specimens were used as the reference standard for calculation of diagnostic accuracy values. Clinically significant prostate cancer (SPCa) was defined as 3 mm core length of Gleason score 3+3 or any Gleason grade 4. Results The sensitivity, specificity, accuracy, and area under the curve (AUC) values for the detection of SPCa on the sextant level for TW+DWI+H-MRS+DCE-MRI were 72%, 89%, 85%, and 0.81, respectively. The corresponding values for Twi+DWI were 61%, 96%, 87%, and 0.79, respectively. The overall PCa detection rate per core in 53 patients was 21% (138 of 648 cores) for SB and 43% (33 of 77 cores) for TB (P<0.001). Conclusion Prebiopsy mpMRI is an accurate tool for PCa detection and biopsy targeting in patients with elevated PSA. J. Magn. Reson. Imaging 2015;41:1394-1404.